Tissue reactions to suture materials in the oral mucosa of beagle dogs

Antimicrobial Activity of Antibacterial Sutures in Oral Surgery: A Scoping Review

OBJECTIVE

The aim of this scoping review was to explore and synthesise the current evidence on the antimicrobial activity of antibacterial suture materials used in oral surgery.

METHODS

The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A bibliographic search was carried out in the PubMed and Scopus databases to retrieve all human clinical studies that investigated the antimicrobial efficacy of antibacterial-coated sutures used in oral surgery. Included studies were screened and extracted independently by 2 examiners. Data were tabulated and qualitatively described.

RESULTS

The search initially returned 150 articles and resulted in 5 included studies after the duplicates' removal and the full-text screening. Selected studies were published from 2014 to 2019. Three studies (60%) were randomised clinical trials, whilst the remaining studies did not report information on randomisation. The antimicrobial agents for coated sutures included triclosan and chlorhexidine. In almost all the studies, antibacterial-coated sutures exhibited lower bacterial retention compared to those without coating.

CONCLUSIONS

Within limitations, the antimicrobial-coated sutures employed in oral surgery exhibited good results in terms of their microbicidal activity when compared with sutures that were not coated. Considering the high variability and confounding factors identified in the included studies, more high-quality research is needed to confirm these results. Antimicrobial-coated sutures could represent a promising and clinically valid strategy to reduce microbial colonisation in oral surgery. The reduced bacterial adherence is likely to improve the clinical success of the surgical procedures. Yet, the cost-benefit ratio of antimicrobial-coated sutures should be assessed in larger clinical trials to confirm their efficacy over conventional noncoated sutures.

Braided silk sutures coated with photoreduced silver nanoparticles for eradicating Staphylococcus aureus and Streptococcus mutans infections

BACKGROUND

Infections resulting from surgical procedures and wound closures continue to pose significant challenges in healthcare settings. To address this issue, the investigators have developed antibacterial non-resorbable braided silk sutures using in situ deposited silver nanoparticles (AgNPs) and investigated their efficacy in eradicating Staphylococcus aureus and Streptococcus mutans infections.

METHODS

The braided silk sutures were modified through a simple and efficient in situ photoreduction method, resulting in the uniform distribution of AgNPs along the suture surface. The synthesized AgNPs were characterized using scanning electron microscopy (SEM), dynamic light scattering analysis (DLS) and Fourier Transform Infrared Spectroscopy analysis (FTIR) confirming their successful integration onto the silk sutures. The antibacterial activity of the nanoparticle coated sutures were compared and evaluated with non-coated braided silk sutures through in vitro assays against both S. aureus and S. mutans.

RESULTS

The surface and cross-sectional analysis of the treated sutures revealed a uniform and homogeneous distribution of silver particles achieved through the photoreduction of silver solution. This observation confirms the successful coating of silver nanoparticles (AgNPs) on the sutures. The antimicrobial studies conducted, demonstrated significant reductions in bacterial colonies when exposed to the silver nanoparticle-coated sutures. Notably, the width of the inhibition zone surrounding the coated sutures remained consistently wide and stable for duration up to 7 days. This sustained and robust inhibitory effect against gram-positive bacteria, specifically S. aureus and S. mutans, serves as strong evidence of the antibacterial efficacy of the coated sutures.

CONCLUSION

The coating of silk sutures with AgNPs provided a significant and effective antibacterial capacity to the surgical sutures, with this activity being sustained for a period of 7 days. This suggests that AgNPs-in situ photoreduction deposited sutures have the potential to effectively manage S. aureus and S. mutans infections.

Microbiological Evaluation of Four Different Suture Materials Used for the Surgical Removal of Impacted Lower Third Molars: A Single-Center Prospective Comparative Study

Introduction Sutures play a crucial role in the postoperative healing process, as they help approximate wound edges, promote hemostasis, and support tissue healing. The oral cavity harbors a diverse microbial population, and oral surgical procedures can introduce potential pathogens into the surgical site. Understanding the impact of suture material on wound infection rates and the colonization of potentially harmful microorganisms is vital for improving patient outcomes. This study was aimed to evaluate and compare the microbiological properties of prolene, vicryl plus, monocryl, and silk sutures used after the surgical removal of impacted lower third molars. Materials and methods A total of 40 patients requiring surgical extraction of impacted lower third molars were assigned to four groups: prolene, vicryl plus, monocryl, and silk sutures. Surgical extraction of impacted tooth was done, and wound was sutured with the abovementioned four different materials in four groups, respectively. After seven days, the sutures were removed and sent to the microbiology lab for colony count assessment. Total microbial colony count, streptococcus count, and lactobacillus count were assessed. Data was analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States) with p-values less than 0.05 considered as statistically significant. The one-way analysis of variance (ANOVA) and post-hoc Tukey test were done to compare intergroup relations. Results The microbiological evaluation of the sutures revealed significant differences in bacterial colonization among the four groups. More bacterial quantities were found in the silk group followed by the monocryl, vicryl plus, and prolene groups in the descending order. Prolene demonstrated the lowest incidence of bacterial growth (p<0.001) compared to vicryl plus, monocryl, and silk sutures. Bacterial colony count was highest in the silk group. The predominant bacterial species found in all groups were Streptococcus viridans, Staphylococcus aureus, and Lactobacillus.  Conclusion It was found that prolene and vicryl plus sutures exhibited superior microbiological properties compared to monocryl and silk sutures when used for the surgical removal of impacted lower third molars. The lower incidence and less quantity of bacterial colonization on prolene sutures suggest their potential for reducing the risk of postoperative infection; hence, these sutures can be preferred for oral surgical procedures.

A novel approach to evaluate the mechanical responses of elastin-like bioresorbable poly(glycolide-co-caprolactone) (PGCL) suture

Poly(glycolide-co-caprolactone) (PGCL) has become a novice to the bioresorbable suture owing to the synergistic properties taken from the homo-polyglycolide (PGA) and polycaprolactone (PCL) such as excellent bioresorption and flexibility. In addition to under conventional monotonic loading, the understanding of mechanical responses of PGCL copolymers under complex loading conditions such as cyclic and stress relaxation is crucial for its application as a surgical suture. Consequently, the present work focuses on evaluating the mechanical responses of PGCL sutures under monotonic, cyclic, and stress relaxation loading conditions. Under monotonic loading, the stress-strain behavior of the PGCL suture was found to be non-linear with noticeable strain-rate dependence. Under cyclic loading, inelastic responses including stress-softening, hysteresis and permanent set were observed. During cyclic loading, both stress-softening and hysteresis were found to increase with the maximum strain. In multi-step stress relaxation, the PGCL sutures were observed to exhibit a strong viscoelastic response. In an attempt to describe the relationship between the stress-relaxation and strain-induced crystallization (SIC) occurring during the loading and relaxation processes, a schematic illustration of the conformational change of polymer chains in PGCL sutures was proposed in this work. Results showed that SIC was dependent on the strain level as well as the loading and relaxation durations. The inelastic phenomena observed in PGCL sutures can be thus correlated to the combined effect of stress relaxation and SIC.

Reoperation on an Implant-Supported Restoration in the Maxillary Anterior Region to Correct a Complex Aesthetic Deficit

Introduction

In an era in which patients are becoming more and more demanding and in which there are many ways to satisfy their needs, modern implantology must consider the correct management of soft tissues during treatment planning, aiming for both functional and aesthetic rehabilitation while creating a prosthetic construction that is in harmony not only with the natural dentition of the patient but also with their face. The patient who came to our notice had a rehabilitative prosthetic implant on the left central incisor area, which did not satisfy any functional or aesthetic parameter. Furthermore, he presented an altered passive eruption in the contralateral hemiarch.

Materials and Methods

The prosthetic crown was removed, the tissues were studied, and the team decided to proceed with customizing a provisional restoration that would cause the soft tissues to descend. A surgical periodontal procedure was then performed to solve the altered passive eruption condition that was also compromising the aesthetics. In conclusion, a permanent prosthetic crown was fixed into place. Discussion. Using a periodontal approach that was both surgical and prosthetic, the patient was rehabilitated correctly regaining both functions and aesthetics. It is of fundamental importance that each step in the procedure is carefully programmed; otherwise, the risk of making mistakes increases and solving the problems becomes less simple or less immediate. In order to do this, one must bear in mind that certain clinical cases can apparently concern just one tooth, yet the mouth must be considered as a whole, both functionally and aesthetically. To perform an optimal implantology, the clinician should be an expert in periodontology so that they can plan and, should it be necessary, perform all the therapeutical options (surgical and nonsurgical) that can lead to the best possible result.

Conclusions

The resolution of this complex clinical case has been documented in order to share useful advice for the resolution of analogous cases. We strongly advise that each proposed procedure be planned meticulously and that the periodontological aspect of the case never be separated from the prosthetic or the implantological aspects since the integration of the periodontal tissues is of vital importance for both the functional and the aesthetic results.

A comparative microbiological study of polyglycolic acid and silk sutures in oral surgical procedures

INTRODUCTION

Bacterial adherence to silk and polyglycolic acid suture is similar. Literature has shown bacterial adhesion is lower degree in polyglycolic acid suture compared to silk, but tissue reaction was more in the polyglycolic acid suture. The aim of the study was to compare the bacteria adhered on the silk and polyglycolic acid sutures.

METHODOLOGY

Sixty two patients who fulfilled the inclusion criteria were included in the study and were divided equally into group A and group B. After intraoral surgical procedures the operated site was sutured either with 3-0 black silk or 3-0 polyglycolic acid sutures in group A and B respectively. On seventh day after irrigation with normal saline sutures were removed and one suture strand was transported to the Department of Microbiology to inoculate and identify the bacteria.

RESULTS

- 3-0 black silk exhibited a high degree of aerobic bacteria. The bacteria identified on the suture were Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus viridians, Enterobacter, Escherichia coli, Citrobacter and Klebseilla. In 3-0 polyglycolic acid suture Pseudomonas aeruginosa, E. coli, Streptococcus Viridians bacteria were identified.

DISCUSSION

- PGA showed fewer bacterial adherences compared to black silk. Fewer bacterial adherence and resorbable PGA makes a better choice for intra oral surgical procedures.

Cadaveric Evaluation of Load to Failure in Canine Gingiva Apposed With Varied Suture Patterns Using Poliglecaprone 25

The purpose of the study was to determine the effect of suture pattern and repair length on the load to failure in an ex vivo canine gingival model. Healthy mandibular gingiva and mucosa were harvested from fresh cadavers euthanized for purposes unrelated to the study. Samples were randomly assigned by length and pattern. Lingual and buccal free gingival margins were apposed using a simple interrupted (SI), cruciate (XT), simple continuous (SC), or unidirectional knotless continuous barbed suture (SF) closure technique with USP 4-0 poliglecaprone 25^{i, ii} applied over 2 lengths (3 cm and 6 cm). A custom template was used to ensure uniform suture bite application. Surgical time was recorded. Using a soft tissue mechanical testing frame, samples were tensioned to failure. Testing was video recorded and reviewed in conjunction with the tension trace data for tension at initial failure (T_fail) and maximum tension sustained (T_max). Two factor ANOVA by length and pattern was performed followed by individual one way T-tests. Statistically significant findings were XT-SC-SF patterns were quicker to perform than SI. SF was more likely to fail by suture breakage than tissue tearing, and SF withstood less tension at the 3 cm length than SI-XT-SC. No significant difference was detected in T_max or T_fail between SI and SC or XT. The study demonstrates that SC and XT are comparable to SI in tension resistance and faster to perform suggesting that SC and XT could replace SI for extraction site closure although further in vivo testing is required.

Comparison between tensile characteristics of various suture materials with two suture techniques: an in vitro study

OBJECTIVE

The first objective of the present study was to evaluate the tensile strength and elongation to failure of commonly used suture materials in oral surgery. As a secondary objective, it was aimed to make a comparison between two different suture techniques within the same suture materials.

MATERIALS AND METHODS

Eight different suture materials with 3-0 gauge (silk, polytetrafluoroethylene, polypropylene, polyester, polyglactin 910, polyglycolic acid, poliglecaprone 25, polydioxanone) underwent tensile testing for maximum load of failure and elongation rate. All strands were tied by one investigator on the experimental platform using the surgeon's knot plus additional square knots in both simple suture and horizontal mattress suture techniques. Prepared specimens were examined using a microtensile testing device before (baseline) and after 3, 7, and 14 days' immersion in artificial saliva.

RESULTS

Statistical analysis of the current study revealed that the tensile strength for polyglycolic acid, polyglactin 910, polypropylene, and silk sutures was significantly lower at day 3 than at the baseline. By day 14, polyglycolic acid and polyglactin 910 showed a significant reduction in tensile strength for both techniques. While polydioxanone obtained the highest tensile strength and elongation values in both techniques, polytetrafluoroethylene showed the most stable tensile strength even with the lowest value. Tensile strength in simple suture techniques was almost twice than that of horizontal mattress suture technique for each specimen.

CONCLUSIONS

Polyglycolic acid and polyglactin 910 were considerably sensitive to immersion time. Polydioxanone demonstrated optimum performance during each immersion period among the tested materials, whereas polytetrafluoroethylene was the most stable.

CLINICAL RELEVANCE

The selection of the most proper suture material remains challenging for clinicians. The present study provides relevant information for clinicians to guide them in their choice of the suitable material. In this context, clinicians can benefit from the use of polydioxanone for its high tensile strength regardless of the suture technique used, whereas polytetrafluoroethylene shows a long-term stability. The strength and stability differences among suture materials and techniques need to be considered before making an informed decision.

In-vitro evaluation of commonly used beverages on tensile strength of different suture materials used in dental surgeries

Sutures are used for the approximation of incised flaps, assistance in primary healing, and hemorrhage control. In oral and periodontal surgery, the appropriate selection of suture material is vital for favorable healing.The aim of the present in-vitro experiment was to evaluate the tensile strengths of 4 different types of suture materials (silk, polygalactine 910, polypropylene, chromic catgut) by simulating potential short-term intraoral exposure to various beverages (saliva, Arabic coffee, tea, cola).A total of 280 suture specimens were prepared, out of which 10 specimens from each group were selected for pre-immersion testing. Remaining suture specimens were immersed in 4 different thermostatically controlled media (1 control [artificial saliva], 3 tests [Cola drink, Arabic coffee, Tea]). Tensile strength was measured at pre-immersion, 3, 7, and 14 days using a universal tensile testing machine. The maximum load required to break the suture material was recorded in Newton.At day 3, tea caused significant reduction in tensile strength of silk and cola caused significant reduction in tensile strengths of polygalactine 910 and chromic catgut. Whereas, at day 7, silk and polypropylene retained their tensile strengths better than others.The authors recommend precaution in the use of these beverages in the first postoperative week, to avoid adverse effect on the mechanical strength of sutures. When exposure to these beverages are anticipated, it is better to use polypropylene sutures that resists rapid fall in tensile strengths in the early postoperative period.

The Effect of Chlorhexidine and Listerine® Mouthwashes on the Tensile Strength of Selected Absorbable Sutures: An In Vitro Study

Background

Suturing plays a critical role in the healing of surgical wounds. The tensile strength of suture materials indicates the ability of the material to withstand stress during knotting and protect the wound during an extended period of healing.

Objective

An in vitro study was conducted to determine the effect of two commercially available mouthwashes on the tensile strength and breakage mode of two absorbable intraoral sutures.

Materials and Methods

Two common absorbable sutures, Vicryl® and Monocryl®, both with 4-0 and 5-0 gauges were used. A total of 400 specimens were sutured around rubber rods and immersed in three thermostatically controlled experimental conditions: artificial saliva, 0.2% chlorhexidine gluconate (Parodontax® extra), and essential oils-based rinse (Listerine® Zero™), and these were compared to a nonimmersed dry condition. All specimens were stored in an incubator at 37°C. Tensile strengths were assessed after days 1, 3, 7, 10, and 14 of immersion using a universal Instron® testing machine. The maximum load for suture breakage and the location of the point of breakage were assessed.

Results

Unlike Monocryl® 4-0, the tensile strength of both gauges of Vicryl® sutures significantly increased in chlorhexidine and Listerine®. There was a significant decrease in the strength for all suture types after day 10, regardless of the immersion solution. Listerine® significantly reduced the tensile strength of Monocryl® 5-0.

Conclusion

Oral surgeons and periodontists should be cautious when prescribing commercial mouthwashes for patients relative to their selection of suture materials. However, further studies are needed to understand the molecular changes in sutures when exposed to chemical solutions found in mouthwashes.

Effects of different suture materials on tissue healing

Purpose:

The purpose of this study was to investigate the healing differences in between four different widely used suture materials in the oral surgery practice, including silk (Perma- Hand; Ethicon, INC., Somerville, NJ, USA), polypropylene (Prolene; Ethicon, INC., Somerville, NJ, USA), coated polyglactin 910 (Ethicon, INC., Somerville, NJ, USA). and polyglecaprone 25 (Ethicon, INC., Somerville, NJ, USA ).

Materials and Methods:

20 male rats were randomly allocated into two groups depending on their sacrification days (post-operative 1st and the 7th days). Four longitudinal incision wounds, each 1cm in size, were created on the dorsum of each animal which were then primarily closed with four different types of sutures.

Results:

The effects of these suture materials on soft tissue healing were compared histopathologically, by means of density of the cells, necrosis, fibrosis, foreign body reaction, the presence of cells of acute and chronic infection. No statistically significant difference was observed between the groups regarding the density of the cells, necrosis, fibrosis, foreign body reaction, and the presence of the cells of acute and chronic infections. Of note, propylene showed slightly less tissue reaction among the other materials.

Conclusion:

The results of our study showed that there is no only one ideal suture material for surgical practice. The factors related to the patient, the type of the surgery and the quality of the tissue are important to decide an appropriate suture material.

Tissue reactivity and suture handling characteristics of "jimat" against silk and chromic gut in cat thigh muscle: A comparative study

AIM

This study was conducted to evaluate and compare the tissue reactivity and suture handling characteristics of chromic gut, silk, and 'jimat' suture materials in cat thigh muscle.

MATERIALS AND METHODS

This experimental study was conducted from November, 2013 to April, 2014 in Kombolcha Animal Diseases Survey, Research and Diagnostic Laboratory, Kombolcha, Ethiopia. A total of 36 local breed male cats were randomly assigned into chromic gut, silk, and "jimat" groups of 12 cats each as A, B, and C, respectively. The hind leg muscle biceps femoris was incised and sutured with suture materials according to their groups. The muscle samples with its suture were collected at six different days interval i.e. 1, 3, 7, 14, 21, and 28 and processed histopathologically to assess the degree of leukocytic infiltration and fibrous and granulation tissue formation (GTF). In addition, all suture materials were evaluated intraoperatively about their handling characteristics, by rating the precision of knot tying, square knot positioning, and resistance to knot slippage. The statistical analysis was done with two-way ANOVA, Kruskal-Wallis, and Chi-square tests.

RESULTS

The histopathology showed that "jimat" thread (2.4±1.2) had produced least leukocytic infiltration than chromic gut (4.5±1.9) and silk (4.3±1.5) sutures during the study period. Higher GTF was seen at day 3 (6 [100%]), 7 (6 [100%]) and day 14 (4 [66.7%]) in all sutures, whereas "jimat" showed significantly (p<0.05) higher fibrous tissue formation (10 [83.3%]) than others. Moreover, "jimat" suture had equal suture handling characteristics (p>0.05) with both chromic gut and silk.

CONCLUSION

The result indicated that a single strand "jimat" thread appears to be the most satisfactory suture material as regards to both tissue reaction and suture handling characteristics for skeletal muscle approximation in cats and provided that studies on its carcinogenic effects should be done.